Dr. Hemang Shah
 I am here to learn
 Patient knows disease the best
 Dr. William Osler: (John Hopkins)
 Seeing patients without reading book
 Reading books without seeing patients
 Confession:
 I am not a movement disorder specialist
 I am not here to drum up the business
Ayurveda
 as far back as 5000 B.C.
 Kampavata = PD
 Atmagupta = tropical
legume called Mucuna
Pruriens
 A natural source of
therapeutic quantities
of L-dopa
Image Courtesy: WikiMedia.org
Huang di nei jing su wen
 500 B.C – Chinese
medical text
 describes the
symptoms of
Parkinson’s Disease.
Name?
 An Essay on the Shaking
Palsy – 1987
 Described 6 patients
 Not actually examined
all of them – saw them
on daily walks
Controversies
 William Shakespeare
(1564-1616), mentioned
“shaking palsy” in the
second part of Henry
VI.
 Hungarian doctor
Pápai Páriz (1649-1716)
book on shaking palsy
in Hungarian.
• The English physician John
Elliotson,
• 1827 to 1831 in the Lancet
• bleeding, induction and
maintenance of pus building,
cauterization, purging, low diet
and mercurialization, silver
nitrate, arsenic, zinc sulphate,
copper compounds, and the
administration of iron as a tonic
with some porter, which is a
kind of dark beer
• “disease instantly and
permanently gave way”
 French doctor Guillame
Benjamin-Amand
Duchenne
 1855 publication "On
localized electrification,
and on its application to
pathology and therapy”
 "galvanism"
 One word – different
 Motor symptoms
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Tremor – unilateral, rest, location, sleep
Rigidity – cogwheel, stiffness, pain, frozen shoulder (?)
Bradykinesia, hypokinesia, pausues, akinesia
Postural instability, festination, camptocormia, en block
turning
 Less recognized motor symptoms
 hypomimia, hypophonia, dysphagia, sialorrhea,
decreased blinking, saccadic pursuit
 Arm swing, micrograhia, dystonia, dyskinesia
 Visual hallucinations, diplopia, impaired visual
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contrast sensitivity, color discrimination etc.
Depression, anxiety, memory problems (dementia)
Neurocognitive dysfunction: executive dysfuntion,
impulse control, interpreting social cues, subjective
awareness of time, increased reaction time
REM Behavior Disorder, insomnia, daytime
hypersomnolence
Autonomic Features: sweating, dizziness, orthostatic
hypotension
Pain
 We don’t know
 Did I do something wrong? – NO
 Minority of patients: genetic (PARK, toxic
(Manganese), head trauma, anti-psychotic
medications
 Balance between Acetylcholine and Dopamine
 Biology:
 http://www.michaeljfox.org/living_popupActionInThe
Brain.cfm
 Essential Tremors
 Hydrocephalus and Normal Pressure Hydrocephalus
 Vascular Parkinsonism
 Encephalitis Lethargica
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http://www.youtube.com/watch?v=Y0sbgJbPgM4
Fragile X Tremor Ataxia Syndrome (FXTAS)
Progressive Supranuclear Palsy (PSP)
Multiple System Atrophy (MSA)
Corticobasal degeneration
Wilson’s Disease
 Amantadine - antiviral
 Anticholinergics
 Levodopa (combined with carbidopa) - sinemet
 MAO-B inhibitors: Selegiline, Rasagiline (Azilect)
 COMT inhibitors – Entacopone (combination –
Stalevo), Tolcapone story
 GENERIC DRUGS
* Ergot-compounds
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- Bromocriptine
- Cabergoline
- Dihydroergocryptine
- Lisuride
- Pergolide
 * Non-ergot compounds
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- Apomorphine
- Piripedil
- Pramipexole
- Ropinirole
 Autonomic dysfunction
 Hypotension
 Urinary dysfunction
 Gastrointestinal dysfunction
 Neuropsychiatric dysfunction
 Treatment of depression
 Treatment of dementia and psychosis
 Sleep problems
 Sailorrhea
 Pain
 Stereotactic Pallidotomy and Thalamotomy
 Deep Brain Stimulation
 Neural Transplantation
 http://www.medtronicdbs.com/parkinsons/index.htm
 http://www.youtube.com/watch?v=EajsKP-
ARIE&feature=player_embedded
http://www.youtube.com/watch?v=-ucwgrxTBEg
 http://www.youtube.com/watch?v=mnRrbP3wY0w
 http://www.youtube.com/watch?v=n1zybXE24JE
 http://www.xbox.com/en-US/Kinect/Fitness
 http://www.parkinsonvoiceproject.org/pvp-
newfilm.html
 http://www.youtube.com/watch?v=aaY3gz5tJSk&featu
re=channel&list=UL
 http://www.medtronicdbs.com/parkinsons/caregiver-
stories/family-experiences/index.htm
 http://davisphinneyfoundation.org/news/cbs4-news-
kcnc-video-davis-talks-living-parkinsons-victorycounts/
 www.apdaparkinson.org
 www.parkinson.org
 www.pdf.org
 www.michaeljfox.org